MEDICARE: DR. RONALD DEAN WEEMS JR. D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1073501672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD DEAN WEEMS JR. D.M.D

Provider Business Mailing Address
First Line	:	1099 BELT LINE RD
Second Line	:	SUITE J-K
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-4380
Country	:	US
Telephone Number	:	618-346-2006
Fax Number	:	618-346-2066

Provider Business Practice Location Address
First Line	:	1099 BELT LINE RD
Second Line	:	SUITE J-K
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-4380
Country	:	US
Telephone Number	:	618-346-2006
Fax Number	:	618-346-2066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

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